Provider Demographics
NPI:1710281050
Name:MCGRATH, KERRY E (LPCT, SACT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:E
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:LPCT, SACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 E JOHNSON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5005
Mailing Address - Country:US
Mailing Address - Phone:608-222-7311
Mailing Address - Fax:
Practice Address - Street 1:25 KESSEL CT
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-0000
Practice Address - Country:US
Practice Address - Phone:608-278-8200
Practice Address - Fax:608-278-8204
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16149-130101YA0400X
WI926-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional